I’m president of the Galen Institute, a non-profit research organization that focuses on market-driven health policy, and a co-author of Why ObamaCare Is Wrong for America (Broadside/HarperCollins, 2011)

The ObamaCare Battlefront Shifts To The States

Throughout the debate over ObamaCare – and back to HillaryCare and beyond – the fundamental question in health reform has always been this: Who will control our choices – government or individuals?

Each side has won battles over the last 15 years in the tug of war between those who want a system that empowers the individual and one that cedes more and more authority to the state.

Congress created the State Children’s Health Insurance Program to expand publicly-financed coverage to children.

But it later created Health Savings Accounts to empower individuals in the free market.

It expanded Medicare to create a new prescription drug benefit.

But it also boosted participation by private plans in Medicare through the Medicare Advantage program.

Back and forth. Back and forth with this political tension as we moved toward 21st century solutions.

But when ObamaCare was slammed through in 2010, we took a screeching left turn toward government control even as citizens marched in the streets and more than 100,000 people called Congress every hour in the days leading up to the vote pleading that their representatives vote “No.” ObamaCare gives only passing lip service to markets and individual choice and did not win a single Republican vote when it passed.

Even after it passed, most Americans continue to opposed the law which they correctly understand will lead to a government-run health care system. Last month, the Kaiser Family Foundation found that only 38% of those polled support the health law. Exit polls on Election Day found that 49% of voters said they wanted all or part of the law repealed, and only 42% said they supported keeping or expanding it – millions fewer than voted to re-elect President Obama.

Those who support government control have leveraged their considerable resources for decades: Left-leaning think tanks with billions of dollars in assets fund study after study showing 1) how inhumane a private system is, and 2) how much better a government-run system would be. Now taxpayer money is being used to support their cause – as directly blatant as HHS buying advertising to promote ObamaCare or as indirect as giving millions of dollars in grants to favored groups to fund studies and advocacy for a government-centered system.

But despite being vastly outnumbered and outspent, the free-market health policy community has been able to explain to the American people what ObamaCare really would do in its Rube Goldberg complexity and collectivism to take away our freedom.

The 2010 elections were a resounding referendum on ObamaCare, a backlash that elected 63 Republicans to the House and six in the Senate, blocking any chance that the Obama administration could get more liberal legislation passed.

The Supreme Court decision was the next chance to stop the law, with major demonstrations outside the court during oral arguments and again three months later, as Chief Justice John Roberts handed down his tortured majority-of-one decision that let the law stand. His decision gave ObamaCare a veneer of legitimacy, and opposition temporarily calmed as a few popular provisions took effect but before the mandates and avalanche of regulations are released that will more fully reveal the cost and intrusiveness of the law.

In early 2012, ObamaCare was a major issue in the Republican presidential primary contests, with the front-runner facing repeated challenges over RomneyCare.

With Gov. Romney leading the ticket, the voters didn’t have a clear choice over the central question of government vs individual control over health care. Romney was unable to focus on the most despised part of ObamaCare – the individual mandate – because he had backed a similar mandate in Massachusetts.

What is that likely to mean? The battlefront now shifts to citizen and state resistance.

The states are the new firewall. Fourteen states have passed legislation, ballot initiatives, or constitutional amendments blocking the individual mandates. A growing number of governors say they will not participate in setting up Exchanges – the bureaucracies that will redesign health insurance and deliver hundreds of billions of dollars in ObamaCare subsidies. Many states also have said they will not expand Medicaid to higher levels, rightly worried that the federal government will lock them into the expansion and then yank back the 100% federal funding match.

Citizens also will resist. With the penalty for not buying insurance starting at $95 the first year, why would someone opt to pay thousands of dollars for health insurance when they know they will be able to buy it when they need it anyway?

And companies already are restructuring their workforces to cut jobs and employee hours to avoid thousands of dollars in ObamaCare fines from the employer mandate – fines many say could completely wipe out the profit margin.

ObamaCare is exponentially more difficult to repeal now, but that doesn’t mean the American people will be any more accepting. It will become increasingly clear that our nation simply can’t afford this massive entitlement at a time that we are facing trillion-dollar-a-year budget deficits as far as the eye can see.

States, individuals, and companies are going to find new ways to rebel against a law that is simply wrong for America.

The nearly 35 lawsuits against the law will continue to make their way through the courts.

The House will hold hearings about the impact of the law in stifling job creation, the crushing burden of $569 billion in new taxes, the costly and burdensome mandates on businesses, individuals, and the states, and the rising costs that add to our shocking national debt.

And those of us in the policy community will continue to make the connection between the law and its consequences as we advance ideas for positive solutions that are right for America.

ObamaCare will fail, but the task of repeal has become much, much more complex and the path forward to right our health sector and economy has become much more difficult. But we will never, never give up in this crucial fight for freedom.

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